NPI 1104585744 · Nurse Practitioner · Anthem
Carrier listings present but Colorado DORA license appears expired or revoked.
NPPES
MONUMENT, 80132
Freshness: Unknown
Network Status
Listed with 8 carriers
DORA License
Expired
Medicare
Not enrolled in Medicare (PECOS)
208 beneficiaries
$27,670.94 total payment
Specialty: Nurse Practitioner
Care Compare
No Care Compare data
PECOS Enrollment
No PECOS data
Active NPI with specialty classification
DORA license expired or revoked
Active Medicare billing confirmed
Single address source (NPPES)
Listed in multiple carrier networks
8 networks across 3 carriers
Disclaimer: This analysis uses publicly available federal and state data sources. It does not constitute a determination of provider status or network participation. Contact the provider or health plan directly to verify current status.